基于视听觉和运动反馈的脑机接口结合经颅直流电刺激对脑卒中患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2024.02.010

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (2): 202-209.doi: 10.3969/j.issn.1006-9771.2024.02.010

基于视听觉和运动反馈的脑机接口结合经颅直流电刺激对脑卒中患者上肢功能的效果

高玲¹^,², 褚凤明¹^,², 贾凡¹^,², 陈杰¹^,², 张明¹^,²^,³()

1.徐州医科大学附属徐州康复医院，江苏徐州市 221003
2.徐州医科大学徐州临床学院/徐州市中心医院，江苏徐州市 221009
3.中国矿业大学机电工程学院，江苏徐州市 221116

收稿日期:2023-11-03 修回日期:2024-01-13 出版日期:2024-02-25 发布日期:2024-03-01
通讯作者: 张明 E-mail:zm1455@163.com
作者简介:高玲(1999-)，女，汉族，山东青岛市人，硕士研究生，主要研究方向：神经康复。
基金资助:
徐州市医学重点人才项目(XWRCHT20220045)

Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients

GAO Ling¹^,², CHU Fengming¹^,², JIA Fan¹^,², CHEN Jie¹^,², ZHANG Ming¹^,²^,³()

1. Xuzhou Rehabilitation Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221003, China
2. Xuzhou Clinical College of Xuzhou Medical University/Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, China
3. School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, Jiangsu 221116, China

Received:2023-11-03 Revised:2024-01-13 Published:2024-02-25 Online:2024-03-01
Contact: ZHANG Ming E-mail:zm1455@163.com
Supported by:
Xuzhou Medical Key Talent Project(XWRCHT20220045)

摘要/Abstract

摘要：

目的探讨基于视听觉和运动反馈的脑机接口(BCI)结合经颅直流电刺激(tDCS)对脑卒中患者上肢功能的疗效。
方法 2023年3月至10月，徐州医科大学附属徐州康复医院和徐州市中心医院住院的脑卒中患者45例，随机分为BCI组、tDCS组和联合组，每组15例。3组均接受常规康复治疗，BCI组增加BCI，tDCS组增加tDCS治疗，联合组先行tDCS治疗，然后立即进行BCI，共4周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、上肢动作研究量表(ARAT)和改良Barthel指数(MBI)进行评定，测量脑电图δ-α比(DAR)和功率比指数(PRI)。
结果治疗后，3组FMA-UE、ARAT和MBI评分均较治疗前显著提高(|t| > 5.350, P < 0.001)，联合组最优(F > 3.366, P < 0.05)，DAR和PRI均较治疗前显著减小(|t| > 2.208, P < 0.05)，联合组最优(F > 5.224, P < 0.01)。
结论基于视听觉和运动反馈的BCI结合tDCS可进一步改善脑卒中患者上肢运动功能，提高日常生活活动能力。

关键词: 脑卒中, 上肢, 脑机接口, 经颅直流电刺激

Abstract:

Objective To explore the effect of brain-computer interface (BCI) based on visual, auditory and motor feedback combined with transcranial direct current stimulation (tDCS) on upper limb function in stroke patients.
Methods From March to October, 2023, 45 stroke inpatients in Xuzhou Rehabilitation Hospital and Xuzhou Central Hospital were divided into BCI group (n = 15), tDCS group (n = 15) and combined group (n = 15) randomly. All the groups received routine rehabilitation, while BCI group received BCI training, tDCS group received tDCS, while the combined group received tDCS and followed by BCI training immediately, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT), modified Barthel Index (MBI) and delta-alpha ratio (DAR) and power ratio index (PRI) of electroencephalogram before and after treatment.
Results The scores of FMA-UE, ARAT and MBI increased in all the groups after treatment (|t| > 5.350, P < 0.001), and all these indexes were the best in the combined group (F > 3.366, P < 0.05); while DAR and PRI decreased in all the groups (|t| > 2.208, P < 0.05), they were the best in the combined group (F > 5.224, P < 0.01).
Conclusion BCI based on visual, auditory and motor feedback combined with tDCS can further improve the motor function of upper limbs and the activities of daily living of stroke patients.

Key words: stroke, upper limb, brain-computer interface, transcranial direct current stimulation

中图分类号:

R743.3

高玲, 褚凤明, 贾凡, 陈杰, 张明. 基于视听觉和运动反馈的脑机接口结合经颅直流电刺激对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(2): 202-209.

GAO Ling, CHU Fengming, JIA Fan, CHEN Jie, ZHANG Ming. Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 202-209.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中性质(出血/梗死)/n	偏瘫侧别(左/右)/n
BCI组	15	12/3	53.20±13.55	64.20±48.02	4/11	7/8
tDCS组	15	12/3	54.60±8.23	70.27±46.49	4/11	6/9
联合组	15	11/4	55.73±8.60	58.47±30.98	5/10	7/8
χ²/F值		0.252	0.223	0.028	0.289	0.180
P值		0.882	0.801	0.973	0.751	0.914

组别	n	治疗前	治疗后	t值	P值
BCI组	15	19.53±11.50	34.80±13.02	-8.698	< 0.001
tDCS组	15	20.93±10.74	32.80±14.34	-6.255	< 0.001
联合组	15	20.67±9.13	44.60±11.34^a,b	-12.194	< 0.001
F值		0.075	3.562
P值		0.928	0.037

组别	n	治疗前	治疗后	t值	P值
BCI组	15	10.47±7.70	21.87±12.77	-5.350	< 0.001
tDCS组	15	12.60±9.96	20.13±10.70	-9.440	< 0.001
联合组	15	12.20±8.60	30.87±11.89^a,b	-9.882	< 0.001
F值		0.249	3.566
P值		0.781	0.037

组别	n	治疗前	治疗后	t值	P值
BCI组	15	50.60±14.38	70.00±15.15	-13.409	< 0.001
tDCS组	15	52.73±12.23	71.67±13.18	-19.856	< 0.001
联合组	15	50.80±9.24	81.27±9.55^a,b	-21.811	< 0.001
F值		0.142	3.366
P值		0.868	0.044

组别	n	治疗前	治疗后	t值	P值
BCI组	15	4.78±2.23	3.84±2.41	2.299	0.037
tDCS组	15	4.38±3.16	3.22±2.00	2.812	0.014
联合组	15	4.40±2.82	1.55±1.50^a,b	3.417	0.004
F值		0.102	5.224
P值		0.903	0.009

基于视听觉和运动反馈的脑机接口结合经颅直流电刺激对脑卒中患者上肢功能的效果

Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients

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组别	n	治疗前	治疗后	t值	P值
BCI组	15	5.16±2.50	4.18±2.20	2.731	0.016
tDCS组	15	4.75±2.77	3.55±1.33	2.208	0.044
联合组	15	4.69±2.59	2.09±1.47^a,b	3.279	0.005
F值		0.139	5.940
P值		0.870	0.005

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